器官移植的發(fā)展與未來課件

器官移植的發(fā)展與未來臺(tái)北榮總一般外科龍藉泉器官移植的發(fā)展與未來臺(tái)北榮總一般外科1Humanchimera,or“homonovo.”Man’soriginalstructurehasbeenmodifiedsothathecanacceptanorgan“fromelsewhere”Humanchimera,or“homonovo.2MythandLegendMythandLegend3MythandLegendMythandLegend4MythandLegendMythandLegend5MythandLegendProf.V.Demikhovandhistwo-headeddog.phototakentwodaysaftertheoperation

U.S.S.R(1950)MythandLegendProf.V.Demikho6MAINSTEPSINGRAFTHISTORYTHEPLANTGRAFT:VERYEARLYINMAN’SHISTORYTHEANIMALGRAFT:18THCENTRURYTHEHUMANGRAFT:18THCENTURYORGANTRANSPLANTATION:20THCENTURYMAINSTEPSINGRAFTHISTORYTHE7FROMGARDENTOFARMYARDFROMGARDENTOFARMYARD8FROMGARDENTOFARMYARDFROMGARDENTOFARMYARD919THCENTURY:ALLFROMSOFGRAFTSBoronio’ssheep(1804).Successfulreplacementskingraftsonthebackofanewe.19THCENTURY:ALLFROMSOFGRA10PaulBertnexttoClaudeBernard,performingavivisectionprocedureinhislaboratoryattheCollegeofFrancein1889.PaulBertnexttoClaudeBerna11Freesplit-skingraftonaburnoftheshoulderandarm.Freesplit-skingraftonabur12THEKIDNEY:APILOTORGANTHEKIDNEY:APILOTORGAN13THEFIRSTTRANSPLANTATIONINANIMAL

AttheViennaMedicalSocietymeetingheldinJanuary1902,thesurgeonEmerichUllmannreportedthefirstcaseofrenaltransplantationperformedintheneckofadog.Theureter,broughtouttotheskin,oozeda“l(fā)iquidwhichresembleurine”overaperiodoffivedays.THEFIRSTTRANSPLANTATIONINA14Dr.AlexisCarrel–AmagicianDr.AlexisCarrel–Amagician15Firstrenaltransplantationsinman:1906-1913In1906,MathieuJaboulayperformedrenaltransplantationinman.Hetransplantedtheleftkidneyofapig,killed3hourspreviously,intotheleftelbowofawomansufferingfromnephroticsyndrome.Thegraftremovedonthethirddayandthevesselswerefoundtobeobstructedbyclots..Firstrenaltransplantationsi16Firsttransplantationbetweenhumans:1933In1933,therussiansurgeonVoronoy(1896-1961)performedthefirsthomologousrenaltransplantationinmanusingahumancadaverkidney.Firsttransplantationbetween17SergeVoronoff,attheCollègedeFrance.Testiculartransplantationfromamonkeytoman.Aretiredindianarmycolonelinfineformaftertheoperation.SergeVoronoff,attheCollège18TheBrighamcommando:1947Ayoungwomanwasinprofoundcomawithanuriafor10daysfollowinganabortioncomplicatedbyacutetubulopathyduetosepticshockandincompatibletransfusion.DavidM.Hume(1917-1973)TheBrighamcommando:1947Ay19Paris,Christmas1952:thepresentfromamothertohersonMrsRenardandhersonMariustowhomshedonatedakidneyinDecember1952.Pelvicimplantationofthekidneywithrestorationoftheurinarytract.Paris,Christmas1952:thepr20ArealSuccess:1954JohnMerrillandJosephMurry(NobelPrize1991)attheBrighamin1953Firstsusccessfultransplantationbetweentwoidenticaltwinsin1954bytheMurry,MerrillandHarrisonteam.ArealSuccess:1954JohnMerr21PeterBrianMedawar,NobelPrizein1960.Rejectionwasbytheactionoflymphocyteswhichdescribedas“immunocomeptentcells“PeterBrianMedawar,NobelPri22MAJORHISTOCOMPATIBILITYCOMPLEX:1952(JeanDausset,NobelPrizein1980)(HumanMHC)MAJORHISTOCOMPATIBILITYCOMPL23Immunosuppression:TotalBodyIrradiation“Sam”and“HonestJohn”Immunosuppression:TotalBody24FirstprolongedsurvivalofrenaltransplantationwithanunrelateddonorMrsGenandherdonoratFochHospitalin1960Firstprolongedsurvivalofre25DevelopmentofImmunosuppressiveDrugsMarianneMattlaerwith“Mana”,whoreceivedakidneyin1960withimmunosuppressionbyazathioprine,withalittertowyearsafterthetransplantation.DevelopmentofImmunosuppressi26AdventofCyclosporineTheprimitivefungusfromwhichcyclosporineisextracted(Tolypocladiuminflatum)SirRoyCalneAdventofCyclosporineTheprim27ProgressinHemodialysis

WilliamJ.Kolff,fatheroftheartificialkidneyandheart.ThefirstartificialkidneydesignedbyKolffin1945.ProgressinHemodialysisWil28TissueTyping“Thecentreeffect”:TerasakiandstatisticsTissueTyping“Thecentreeffec29OrganPreservationFalkertO.Belzer.ThefirsthumankidneypreservedonaperfusionmachinepriortotransplantationinAugust1967.OrganPreservationFalkertO.B30OrganPreservationOrganPreservation31LiverTransplantationThomasStarzlintheoperatingroomonMarch1,1963,performedthefirstlivertransplantation,therecipientsurvivedfivehoursafterthetransplantation.LiverTransplantationThomasSt32OilpaintingbySirRoyCalne(1990)representaphaseoflivertransplantationcoordinatedbytheentiresurgicalteam.OilpaintingbySirRoyCalne33PancreasandIntestinalTransplantationRichardLilleheiPancreasandIntestinalTransp34HeartandLungTransplantationDeniseDarvall,thefirsthumanheart”donor”

LouisWashkansky,theheartrecipient.December3,1967.ChristiaanN.Barnard,cardiovascularsurgeonatCapetown.HeartandLungTransplantation35ArtificialHeartArtificialHeart36HeartandLungTransplantationJamesD.Hardy’steam,performedthefirsthumanlungtransplantationonJune11,1963,sevenandahalfmonthsbeforetheyperformedthefirsthumanheterologushearttransplantation.HeartandLungTransplantation37XenotransplantationThefirstbloodtransfusionfromanimalstomanwereattemptedin1628.XenotransplantationThefirstb38XenotransplantationXenotransplantation39器官移植在臺(tái)灣的發(fā)展腎臟1968.05.27臺(tái)大李俊仁自體骨髓1983.11.09臺(tái)大陳耀昌異體骨髓1984.03.09臺(tái)大陳耀昌肝臟1984.03.22長庚陳肇隆胰臟1984.04.01長庚陳肇隆心臟1987.07.17臺(tái)大朱樹勳肺臟1991.07.10北榮王良順器官移植在臺(tái)灣的發(fā)展腎臟1968.05.40臺(tái)灣器官移植之父臺(tái)灣器官移植之父41臺(tái)灣肺臟移植的先驅(qū)王良順教授，臺(tái)北榮總呼吸加護(hù)病房主任臺(tái)灣肺臟移植的先驅(qū)王良順教授，臺(tái)北榮總呼吸加護(hù)病房主任42Howthetransplantationisdoing?Howthetransplantationisdoi43Howthetransplantationisdoing?Howthetransplantationisdoi44SPKT

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45LiverandPancreasinBackTableLiverandPancreasinBackTab46Y-graftReconstructionSMASAEIAIIACIAY-graftReconstructionSMASAEIA47PancreasTransplantation

Cold/WarmIschemicTime=452min/38minPVDuodenumgraftY-grafta.PancreasgraftPancreasTransplantation

Cold/48Duodeno-jejunostomyinSPKTPancreasDuodeno-jejunostomyinSPKTPa